Improving Symptoms and Quality of Life in Advanced Chronic Heart Failure Chronic heart failure (HF) patients suffer from numerous symptoms such as breathlessness, fatigue, and pain that worsen quality of life. Prior palliative symptom management interventions have generally not succeeded in improving symptoms in HF patients. Our preliminary studies show the importance and feasibility of providing psychosocial care to address the depression that intensifies other symptoms and integrating palliative care earlier into ongoing HF care. Adding these components to palliative symptom management offers a potentially successful strategy to reduce symptom severity and depression and thus improve quality of life in HF patients. This research is an integral part of a long term goal to improve symptoms and thus quality of life in patients with advanced HF. The specific aims of this proposal are to: (1) Assess the effect of a palliative symptom management and psychosocial care intervention on symptom severity and depression as primary endpoints, and symptom distress, adjustment to illness, self-care, and spiritual well-being as pre-specified secondary endpoints; (2) Evaluate whether the intervention influences quality of life indirectly through effects on symptom severity and depression. A 3-site, 2-arm randomized, controlled, clinical trial of 312 patients will be conducted in a single geographic region. Measures of symptom severity, depression, adjustment to illness, self-care, spiritual well-being, and quality o life will be collected at baseline, 3, 6, and 12 months. Hypotheses will be tested using mixed effects and structural equation models. Collectively, the proposed studies will impact clinical care for patients with HF by testing an innovative, evidence-based, theory-driven palliative symptom management and psychosocial care intervention and informing continued development of targeted interventions to improve outcomes. The core components of the intervention are structured to ease replication, implementation, and dissemination, and we plan subsequent studies to conduct an economic analysis of the intervention and to determine if the intervention has an effect on health care utilization and survival. This study will contribute to a key gap in HF and palliative care research and is directly linked to the goals of RFA-NR-11-006.